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foundations of paramedic practice 2 > abdominal assessment and management > Flashcards

abdominal assessment and management Flashcards

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1
Q

why do we need to assess an abdomen

A

gi/gu problems

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2
Q

what are we assessing abdo for

A

pain
swelling
abnormalities

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3
Q

how to we assess abdomen

A

IAPP
inspection
auscultation
percussion
palpation

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4
Q

what do we ask for history take

A
  • nausea
  • haemetemesis (vommiting blood)
  • anorexia (not eating)
  • type of pain (SOCRATES)
  • pain on passing urine
  • migration of pain
  • weightloss
  • haematuria (blood on urine)
  • diarrhoea
  • pale/yellow bowel movement
  • painless jaundice
  • anuria (no urine)
  • absence of passing uring/ bowel opening
  • jaundice
  • malaena (black tar stools)
  • vomitting
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5
Q

what to assess on hands

A
  • Leukonychia
  • Koilonychia
  • Splinter haemorrhages
  • Finger clubbing
  • Pallor
  • Palmar erythema
  • Dupytren’s Contracture
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6
Q

what to assess on arms

A
  • Pulses
  • Track marks
  • Excoriations
  • Asterixis
  • Bruises
  • Scarring
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7
Q

what to assess on face

A
  • Xanthelasma
  • Jaundice
  • Conjunctival pallor
  • Corneal arcus
  • Oral candida
  • Angular stomatitis
  • Mouth ulcers
  • Poor dentition
    *
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8
Q

what to assess on neck

A
  • JVD
  • Supraclavicar lymph node swelling (Virchow’s node)
  • Swelling
    *
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9
Q

what to assess on chest

A
  • Spider Naevi
  • Gynaecomastia
  • Hair loss
  • Pectus carinatum
  • Pectus excavatum
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10
Q

what position do we want to the patient to be during abdo ax

A

supine

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11
Q

what organs are in the right upper quadrant

A

Ascending colon
Duodenum Gallbladder
Kidney (right)
Liver
Head of pancreas
Transverse colon
Ureter (right)

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12
Q

what organs are in the left upper quadrant

A

Descending Colon
Kidney (left)
Pancreas (Body and tail)
Spleen
Stomach
Transverse colon
Ureter (leff)

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13
Q

what organs are in the right lower quadrant

A

Appendix
Ascending colon
Bladder
Caecum
Rectum
Ovary, uterus, and fallopian tube (female)
Prostate and spermatic cord (male)
Small intestine
Ureter (right)

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14
Q

what organs are in the left lower quadrant

A

Bladder
Descending colon
Ovary, uterus, and fallopian tube (female)
Prostate and spermatic cord (male)
Small intestine
Sigmoid colon
Ureter (left)

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15
Q

what to inspect for abdo assessment

A

fat
fluid
flatus (farts)
faeces
fetus
mass

varicose veins
cullens sign - bruising to bellybutton
grey turners sign- bruising to side
scars
distension
stretch marks
stoma
hernia (how long, pain)
spider nevi- high levels of oestrogen

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16
Q

what to listen for in auscultation in abdo assessment

A

bowel sounds
four quadrants

listen for bruits

17
Q

what do bowel sounds mean

A
  • Normal bowel sounds:typically described as gurgling
  • Tinkling bowel sounds:typically associated with bowel obstruction.
  • Absent bowel sounds:suggests ileus which is a disruption of the normal propulsive ability of the intestine due to a malfunction of peristalsis. Causes of ileus include electrolyte abnormalities and recent abdominal surgery.
  • To be able to confidently state that a patient has ‘absent bowel sounds’ you need to auscultate for at least 3 minutes (this is unlikely to be the case in an OSCE given the time restraints).
18
Q

where do you listen for bruits and what do they mean

A

Aortic bruits:auscultate 1-2 cm superior to the umbilicus, a bruit here may be associated with an abdominal aortic aneurysm.
Renal bruits:auscultate 1-2 cm superior to the umbilicus and slightly lateral to the midline on each side. A bruit in this location may be associated with renal artery stenosis.

19
Q

what do you percussion for in abdo ax

A

percuss nine areas
hyper/hyporesonance

liver
start at right iliac and move up until it is dull
carry and and move into ribe in the intercostal space- when hyper again you are at lung

spleen
start at right iliac and move across the abdomen and up but should not hear spleen

shifting dullness
ascites is fluid in the abdomen- shifting dullness would indicate this
start on ummbilical region and go sideways and if there is dullness turn patient onto RHS and percuss again and fluid will have moved onto right hip and laft side will not be dull

renal angle
percussion of kidneys (sit at bottom of ribs at back) see if it worsens pain- place hand and hit hand

20
Q

what do we need to think about palpation for abdominal ax

A

9 areas
wave hand
tenderness, masses, hernias, distended bladded

one hand then two handed more firmly

palpate liver edge and spleen
start at right iliac fossa and ask patient to take deep breaths- feel it when they breath in and move up one cm each time

21
Q

additional tests for abdominal ax

A

murpheys (gallbladder, deep breath)
psoas
rosvings
obturator
heelstrike
rebound tenderness
guarding (protecting against pain)
dre

22
Q

what are the choles

A

severe upper right abdo pain
fluctuating but always present
occulsion of the cystic duct of the gall bladder
left untreatd can result in sepsis

23
Q

what is UGIB and LGIB

A

upper GI bleed and lower GI bleed

24
Q

signs and symptoms of UGIB and LGIB

A

malaena or haematemesis

25
Q

what to think about with UGIB and LGIB

A
  • blood loss
  • fluid replacement
  • may need resus depending on severity
  • oesophageal varices
26
Q

what can cause lower GI bleeding

A
  • Diverticulosis (colonic wall protrusion at the site of penetrating vessels; over timemucosa overlying the vessel can be injured and rupture leading to bleeding) [diverticulosis]
  • Angiodysplasia
  • Infectious colitis
  • Ischemic colitis
  • Inflammatory bowel disease
  • Colon cancer
  • Hemorrhoids
  • Anal fissures
  • Rectal varices
  • Dieulafoy lesion (more rarely found outside of the stomach, but can be found throughout GI tract)
  • Radiation-induced damage following treatment of abdominal or pelvic cancers
  • Post-surgical (post-polypectomy bleeding, post-biopsy bleeding)
27
Q

what can cause upper GI bleeding

A
  • Peptic ulcer disease (can be secondary to excess gastric acid, H. pylori infection, NSAID overuse, or physiologic stress)
  • Esophagitis
  • Gastritis and Duodenitis
  • Varices
  • Portal hypertensive gastropathy (PHG)
  • Angiodysplasia
  • Dieulafoy lesion (bleeding dilated vessel that erodes through the gastrointestinal epithelium but has no primary ulceration; can be at any location along the GI tract[1]
  • Gastric antral valvular ectasia (GAVE;also known as watermelon stomach)
  • Mallory-Weiss tears
  • Cameron lesions (bleeding ulcers occurring at the site of a hiatal hernia[2]
  • Aortoenteric fistulas
  • Foreign body ingestion
  • Post-surgical bleeds (post-anastomotic bleeding, post-polypectomy bleeding, post-sphincterotomy bleeding)
  • Upper GI tumors
  • Hemobilia(bleeding from the biliary tract)
  • Hemosuccus pancreaticus(bleeding from the pancreatic duct)
28
Q

what ligament is the split between upper and lower GI bleed

A

ligament of treitz

29
Q

what is the cause of appendicitis

A

Appendicitisis primarily caused by obstruction of the appendiceal lumen leading to inflammation. The obstruction can be due to various factors such as appendicoliths, appendiceal tumors, intestinal parasites, or hypertrophied lymphatic tissues. These mechanical obstructions result in the development of acuteappendicitis. It is important to note that the underlying causes of luminal obstructions may vary among different age groups, highlighting the need for age-specific considerations when evaluating and managingappendicitis.

Most commonly in 5-45 but can occur at any age.

30
Q

where does the pain go in appendicitis

A

starts in umbilicus and migrates to McBurneys point (3/4 the way between right iliac and belly button)

31
Q

tests for appendicitis

A

rebound tenderness, rosvings sign, psoas sign, obturator sign, heel strike tenderness

32
Q

signs of appendicitis

A

Within hours, the pain travels to your lower right-hand side, where the appendix is usually located, and becomes constant and severe.

Pressing on this area, coughing or walking may make the pain worse.

If you have appendicitis, you may also have other symptoms, including:

feeling sick (nausea)
being sick
loss of appetite
constipation or diarrhoea
a high temperature and a flushed face

33
Q

what do you need to remember with AAA

A

do not poke it
paramedic backup
be prepared for an arrest
drive fast SKRTTTTTT

34
Q
A

foundations of paramedic practice 2 (5 decks)

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